Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR UNLISTED PROCEDURE - LIVER

Facility

$2,392.95

Service Code	HCPCS 47399
Hospital Charge Code	7411556
Hospital Revenue Code	361
Min. Negotiated Rate	$358.94
Max. Negotiated Rate	$358.94
Rate for Payer: Qualcare PPO/HMO/WC	$358.94

IR UNLISTED PROCEDURE - LIVER

Facility

$3,392.55

Service Code	HCPCS 47399
Hospital Charge Code	321047399
Hospital Revenue Code	361
Min. Negotiated Rate	$508.88
Max. Negotiated Rate	$508.88
Rate for Payer: Qualcare PPO/HMO/WC	$508.88

IR UNLISTED VASCULAR PROCEDUR

Facility

$258.70

Service Code	HCPCS 37799
Hospital Charge Code	7411541
Hospital Revenue Code	361
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

IR UNLISTED VASCULAR PROCEDUR

Facility

$3,630.70

Service Code	HCPCS 37799
Hospital Charge Code	321037799
Hospital Revenue Code	361
Min. Negotiated Rate	$544.61
Max. Negotiated Rate	$544.61
Rate for Payer: Qualcare PPO/HMO/WC	$544.61

IR UNLISTED VASCULAR PROCEDUR

Facility

$258.70

Service Code	HCPCS 37799
Hospital Charge Code	7411541
Hospital Revenue Code	361
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,027.08
Rate for Payer: Aetna Medicare Advantage	$2,414.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$745.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,690.13
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: Cigna Medicare Advantage	$745.25
Rate for Payer: Clover Medicare Advantage	$707.99
Rate for Payer: EmblemHealth Commercial	$2,235.75
Rate for Payer: Humana Medicare Advantage	$767.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$745.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.61
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.80
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$6.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25
Rate for Payer: Wellpoint Medicaid Managed Care	$6.86

IR UNLISTED VASCULAR PROCEDUR

Facility

$3,630.70

Service Code	HCPCS 37799
Hospital Charge Code	321037799
Hospital Revenue Code	361
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,027.08
Rate for Payer: Aetna Medicare Advantage	$2,414.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$745.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,690.13
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: Cigna Medicare Advantage	$745.25
Rate for Payer: Clover Medicare Advantage	$707.99
Rate for Payer: EmblemHealth Commercial	$2,235.75
Rate for Payer: Humana Medicare Advantage	$767.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$745.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.21
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$544.61
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$87.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25
Rate for Payer: Wellpoint Medicaid Managed Care	$96.21

IR UNLISTED VASCULAR PROCEDUR

Facility

$3,630.70

Service Code	HCPCS 37799
Hospital Charge Code	2600185
Hospital Revenue Code	361
Min. Negotiated Rate	$544.61
Max. Negotiated Rate	$544.61
Rate for Payer: Qualcare PPO/HMO/WC	$544.61

IR UNLISTED VASCULAR PROCEDUR

Facility

$3,630.70

Service Code	HCPCS 37799
Hospital Charge Code	2600185
Hospital Revenue Code	361
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,027.08
Rate for Payer: Aetna Medicare Advantage	$2,414.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,690.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$745.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,690.13
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: Cigna Medicare Advantage	$745.25
Rate for Payer: Clover Medicare Advantage	$707.99
Rate for Payer: EmblemHealth Commercial	$2,235.75
Rate for Payer: Humana Medicare Advantage	$767.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$745.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.21
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$544.61
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$87.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25
Rate for Payer: Wellpoint Medicaid Managed Care	$96.21

IR UNLISTE PROCEDURE URINARY

Facility

$461.14

Service Code	HCPCS 53899
Hospital Charge Code	2680220
Hospital Revenue Code	361
Min. Negotiated Rate	$69.17
Max. Negotiated Rate	$69.17
Rate for Payer: Qualcare PPO/HMO/WC	$69.17

IR UNLISTE PROCEDURE URINARY

Facility

$461.14

Service Code	HCPCS 53899
Hospital Charge Code	2680220
Hospital Revenue Code	361
Min. Negotiated Rate	$11.11
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$807.38
Rate for Payer: Aetna Medicare Advantage	$961.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,071.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,071.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$296.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,071.47
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: Cigna Medicare Advantage	$296.83
Rate for Payer: Clover Medicare Advantage	$281.99
Rate for Payer: EmblemHealth Commercial	$890.49
Rate for Payer: Humana Medicare Advantage	$305.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$296.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.34
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$11.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$296.83
Rate for Payer: Wellcare Medicare Advantage	$296.83
Rate for Payer: Wellpoint Medicaid Managed Care	$12.22

IR UNLISTE PROCEDURE URINARY

Facility

$461.14

Service Code	HCPCS 53899
Hospital Charge Code	7411632
Hospital Revenue Code	361
Min. Negotiated Rate	$11.11
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$807.38
Rate for Payer: Aetna Medicare Advantage	$961.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,071.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,071.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$296.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,071.47
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: Cigna Medicare Advantage	$296.83
Rate for Payer: Clover Medicare Advantage	$281.99
Rate for Payer: EmblemHealth Commercial	$890.49
Rate for Payer: Humana Medicare Advantage	$305.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$296.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.34
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$11.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$296.83
Rate for Payer: Wellcare Medicare Advantage	$296.83
Rate for Payer: Wellpoint Medicaid Managed Care	$12.22

IR UNLISTE PROCEDURE URINARY

Facility

$461.14

Service Code	HCPCS 53899
Hospital Charge Code	7411632
Hospital Revenue Code	361
Min. Negotiated Rate	$69.17
Max. Negotiated Rate	$69.17
Rate for Payer: Qualcare PPO/HMO/WC	$69.17

IR-URETERO THR URE INJ-BI

Facility

$894.00

Service Code	HCPCS 5068450
Hospital Charge Code	2690670
Hospital Revenue Code	761
Min. Negotiated Rate	$21.55
Max. Negotiated Rate	$447.00
Rate for Payer: Aetna Commercial	$339.72
Rate for Payer: Aetna Medicare Advantage	$268.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.97
Rate for Payer: Cigna Commercial	$447.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.20
Rate for Payer: Oxford Commercial	$178.80
Rate for Payer: Qualcare PPO/HMO/WC	$134.10
Rate for Payer: UnitedHealthcare Commercial	$178.80
Rate for Payer: UnitedHealthcare Community & State	$21.55
Rate for Payer: Wellpoint Medicaid Managed Care	$23.69

IR-URETERO THR URE INJ-BI

Facility

$894.00

Service Code	HCPCS 5068450
Hospital Charge Code	7411827
Hospital Revenue Code	761
Min. Negotiated Rate	$21.55
Max. Negotiated Rate	$447.00
Rate for Payer: Aetna Commercial	$339.72
Rate for Payer: Aetna Medicare Advantage	$268.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.97
Rate for Payer: Cigna Commercial	$447.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.20
Rate for Payer: Oxford Commercial	$178.80
Rate for Payer: Qualcare PPO/HMO/WC	$134.10
Rate for Payer: UnitedHealthcare Commercial	$178.80
Rate for Payer: UnitedHealthcare Community & State	$21.55
Rate for Payer: Wellpoint Medicaid Managed Care	$23.69

IR-URETERO THR URE INJ-BI

Facility

$894.00

Service Code	HCPCS 5068450
Hospital Charge Code	2690670
Hospital Revenue Code	761
Min. Negotiated Rate	$134.10
Max. Negotiated Rate	$134.10
Rate for Payer: Qualcare PPO/HMO/WC	$134.10

IR-URETERO THR URE INJ-BI

Facility

$894.00

Service Code	HCPCS 5068450
Hospital Charge Code	7411827
Hospital Revenue Code	761
Min. Negotiated Rate	$134.10
Max. Negotiated Rate	$134.10
Rate for Payer: Qualcare PPO/HMO/WC	$134.10

IR-URETERO THR URE INJ-LT

Facility

$894.00

Service Code	HCPCS 50684LT
Hospital Charge Code	2691680
Hospital Revenue Code	761
Min. Negotiated Rate	$134.10
Max. Negotiated Rate	$134.10
Rate for Payer: Qualcare PPO/HMO/WC	$134.10

IR-URETERO THR URE INJ-LT

Facility

$894.00

Service Code	HCPCS 50684LT
Hospital Charge Code	7411976
Hospital Revenue Code	761
Min. Negotiated Rate	$21.55
Max. Negotiated Rate	$447.00
Rate for Payer: Aetna Commercial	$339.72
Rate for Payer: Aetna Medicare Advantage	$268.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.97
Rate for Payer: Cigna Commercial	$447.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.20
Rate for Payer: Oxford Commercial	$178.80
Rate for Payer: Qualcare PPO/HMO/WC	$134.10
Rate for Payer: UnitedHealthcare Commercial	$178.80
Rate for Payer: UnitedHealthcare Community & State	$21.55
Rate for Payer: Wellpoint Medicaid Managed Care	$23.69

IR-URETERO THR URE INJ-LT

Facility

$894.00

Service Code	HCPCS 50684LT
Hospital Charge Code	7411976
Hospital Revenue Code	761
Min. Negotiated Rate	$134.10
Max. Negotiated Rate	$134.10
Rate for Payer: Qualcare PPO/HMO/WC	$134.10

IR-URETERO THR URE INJ-LT

Facility

$894.00

Service Code	HCPCS 50684LT
Hospital Charge Code	2691680
Hospital Revenue Code	761
Min. Negotiated Rate	$21.55
Max. Negotiated Rate	$447.00
Rate for Payer: Aetna Commercial	$339.72
Rate for Payer: Aetna Medicare Advantage	$268.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.97
Rate for Payer: Cigna Commercial	$447.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.20
Rate for Payer: Oxford Commercial	$178.80
Rate for Payer: Qualcare PPO/HMO/WC	$134.10
Rate for Payer: UnitedHealthcare Commercial	$178.80
Rate for Payer: UnitedHealthcare Community & State	$21.55
Rate for Payer: Wellpoint Medicaid Managed Care	$23.69

IR-URETERO THR URE INJ-RT

Facility

$894.00

Service Code	HCPCS 50684RT
Hospital Charge Code	2691685
Hospital Revenue Code	761
Min. Negotiated Rate	$21.55
Max. Negotiated Rate	$447.00
Rate for Payer: Aetna Commercial	$339.72
Rate for Payer: Aetna Medicare Advantage	$268.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.97
Rate for Payer: Cigna Commercial	$447.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.20
Rate for Payer: Oxford Commercial	$178.80
Rate for Payer: Qualcare PPO/HMO/WC	$134.10
Rate for Payer: UnitedHealthcare Commercial	$178.80
Rate for Payer: UnitedHealthcare Community & State	$21.55
Rate for Payer: Wellpoint Medicaid Managed Care	$23.69

IR-URETERO THR URE INJ-RT

Facility

$894.00

Service Code	HCPCS 50684RT
Hospital Charge Code	2691685
Hospital Revenue Code	761
Min. Negotiated Rate	$134.10
Max. Negotiated Rate	$134.10
Rate for Payer: Qualcare PPO/HMO/WC	$134.10

IR-URETERO THR URE INJ-RT

Facility

$894.00

Service Code	HCPCS 50684RT
Hospital Charge Code	7411977
Hospital Revenue Code	761
Min. Negotiated Rate	$21.55
Max. Negotiated Rate	$447.00
Rate for Payer: Aetna Commercial	$339.72
Rate for Payer: Aetna Medicare Advantage	$268.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.97
Rate for Payer: Cigna Commercial	$447.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.20
Rate for Payer: Oxford Commercial	$178.80
Rate for Payer: Qualcare PPO/HMO/WC	$134.10
Rate for Payer: UnitedHealthcare Commercial	$178.80
Rate for Payer: UnitedHealthcare Community & State	$21.55
Rate for Payer: Wellpoint Medicaid Managed Care	$23.69

IR-URETERO THR URE INJ-RT

Facility

$894.00

Service Code	HCPCS 50684RT
Hospital Charge Code	7411977
Hospital Revenue Code	761
Min. Negotiated Rate	$134.10
Max. Negotiated Rate	$134.10
Rate for Payer: Qualcare PPO/HMO/WC	$134.10

IR-URETHROGRAM VOIDING

Facility

$769.00

Service Code	HCPCS 51600
Hospital Charge Code	2670225
Hospital Revenue Code	361
Min. Negotiated Rate	$115.35
Max. Negotiated Rate	$115.35
Rate for Payer: Qualcare PPO/HMO/WC	$115.35

Know your out-of-pocket cost for care.

All Charges